Effective Disinfection of Orthodontic Pliers

Objective:: Pathogenic microbes may be transmitted directly from the orthodontist to the patient or from the patient to the doctor, and indirectly from patient to patient. The latter may occur via contaminated instruments or surfaces, and is referred to as cross-contamination. The objective of this study was to evaluate the extent of bacterial contamination of orthodontic pliers and the efficacy of the disinfection techniques applied after clinical use. We also sought to examine under standardized conditions the virucidal, bactericidal and fungicidal effects of disinfection techniques used in practice. Materials and Methods:: The efficacy of various disinfection methods was determined after clinical use in-vivo on 10 test subjects and in-vitro with deliberate contamination. The following disinfection methods were tested: 1. Iso-Septol spray 2. Incidur® spray 3. Trough disinfection in combination with 5% Sekusept® Plus solution 4. Ultrasound bath in combination with 5% Sekusept® Plus solution 5. Thermal disinfection For in-vitro contamination we used the test organisms Staphylococcus aureus, Escherichia coli, Candida albicans, Coxsackie virus B4, HSV 1, and Adenovirus type 5. The tests were carried out six to eight times for each organism. The Weingart pliers and distalend cutters were tested. The criteria for effective disinfection were a reduction in infectiosity of five log steps (for bacteria and fungi) or four log steps (viruses). Statistical analysis was carried out using the Wilcoxon and Whitney U-test. Results:: The presence of contamination following clinical use was not adequately eliminated with all disinfection methods. The spray methods exhibited shortcomings in disinfection. For the type of contamination defined, trough disinfection with 5% Sekusept® Plus and the Incidur® and Iso-Septol spray disinfection methods provided insufficient disinfection. Conversely, the ultrasound bath with 5% Sekusept® Plus solution and steam disinfection met the criteria for effective disinfection for all microbes. No statistically significant difference was found between the oiled and unoiled states. In some cases, there were slightly higher rates of contamination with the Weingart pliers as with the distalend cutters. However, these were not statistically significant. Conclusions:: It should be possible to disinfect lipophilic viruses and the usual bacterial infections adequately with all methods, provided that the use of sprays and trough disinfection is preceded by cleaning with brush and water, followed by drying. With hydrophilic viruses, however, the spray and trough disinfection methods are limited in their efficacy and cannot be considered adequate. Exclusively chemical methods are therefore less effective than thermal or physical-chemical methods. Thermal disinfection and the ultrasound bath in combination with 5% Sekusept® Plus are clearly superior to spray disinfection and trough disinfection alone. The ultrasound bath and thermal disinfection can therefore be recommended for the disinfection of orthodontic pliers. We recommend that the pliers be cleaned beforehand due to their uneven surface

Accuracy of 3D Tooth Movements in the Fabrication of Manual Setup Models for Aligner Therapy

Background: The clinical outcome of aligner therapy is closely related to the precision of its setup, which can be manually or digitally fabricated. The aim of the study is to investigate the suitability of manual setups made for aligner therapy in terms of the precision of tooth movements. Methods: Six dental technicians were instructed to adjust each of eleven duplicate plaster casts of a patient models as follows: a 1 mm pure vestibular translation of tooth 11 and a 15° pure mesial rotation of tooth 23. The processed setup models were 3D scanned and matched with the reference model. The one-sample Wilcoxon signed-rank test (p < 0.05) was used for evaluation. Results: The overall precision of the translational movement covers a wide range of values from 0.25 to 2.26 mm (median: 1.09 mm). The target value for the rotation of tooth 23 was achieved with a median rotation of 9.76° in the apical-occlusal direction. Unwanted movements in the other planes also accompanied the rotation. Conclusions: A manual setup can only be fabricated with limited precision. Besides the very high variability between technicians, additional unwanted movements in other spatial planes occurred. Manually fabricated setups should not be favored for aligner therapy due to limited precision

Exclusion of Mucorales Co-Infection in a Patient with Aspergillus flavus Sinusitis by Fluorescence In Situ Hybridization (FISH)

Invasive fungal infections are associated with increased mortality in hematological patients. Despite considerable advances in antifungal therapy, the evaluation of suspected treatment failure is a common clinical challenge requiring extensive diagnostic testing to rule out potential causes, such as mixed infections. We present a 64-year-old patient with secondary AML, diabetes mellitus, febrile neutropenia, and sinusitis. While cultures from nasal tissue grew Aspergillus flavus, a microscopic examination of the tissue was suggestive of concomitant mucormycosis. However, fluorescence in situ hybridization (FISH) using specific probes targeting Aspergillus and Mucorales species ruled out mixed infection. This was confirmed by specific qPCR assays amplifying the DNA of Aspergillus, but not of Mucorales. These results provided a rational basis for step-down targeted therapy, i.e., the patient received posaconazole after seven days of calculated dual therapy with liposomal amphotericin B and posaconazole. Despite clinical response to the antifungal therapy, he died due to the progression of the underlying disease within two weeks after diagnosis of fungal infection. Molecular diagnostics applied to tissue blocks may reveal useful information on the etiology of invasive fungal infections, including challenging situations, such as with mixed infections. A thorough understanding of fungal etiology facilitates targeted therapy that may improve therapeutic success while limiting side effects.Peer Reviewe

Evaluation of Various Culture Media for Detection of Rapidly-Growing Mycobacteria from Patients with Cystic Fibrosis.

Isolation of nontuberculous mycobacteria (NTM) from the sputum of patients with cystic fibrosis (CF) is challenging due to overgrowth by rapidly growing species that colonize the lungs of patients with CF. Extended incubation on Burkholderia cepacia selective agar (BCSA) has been recommended as an expedient culture method for the isolation of rapidly growing NTM in this setting. The aim of this study was to assess five selective media designed for the isolation of Burkholderia cepacia complex, along with two media designed for the isolation of mycobacteria (rapidly growing mycobacteria [RGM] medium and Middlebrook 7H11 agar), for their abilities to isolate NTM. All seven media were challenged with 147 isolates of rapidly growing mycobacteria and 185 isolates belonging to other species. RGM medium was then compared with the most selective brand of BCSA for the isolation of NTM from 224 sputum samples from patients with CF. Different agars designed for the isolation of B. cepacia complex varied considerably in their inhibition of other bacteria and fungi. RGM medium supported the growth of all isolates of mycobacteria and was more selective than any other medium. NTM were recovered from 17 of 224 sputum samples using RGM medium, compared with only 7 samples using the most selective brand of BCSA (P = 0.023). RGM medium offers a superior option, compared to other selective agars, for the isolation of rapidly growing mycobacteria from the sputum of patients with CF. Furthermore, the convenience of using RGM medium enables routine screening for rapidly growing NTM in all submitted sputum samples from patients with CF

Edelstahl- und NiTi-Torquesegmentbogen und apikale Wurzelresorption

OBJECTIVE The amount of apical root resorption when using the torque-segmented archwire (TSA) was investigated as well as the extent and direction of the therapeutically indicated apical movement and the treatment duration. MATERIALS AND METHODS The degree of apical root resorption in 18 randomly chosen Class II and Class I patients treated with the TSA, as well as in 18~conventionally treated patients were evaluated using pre- and posttreatment panoramic radiographs. The sagittal and vertical apical movements and inclination changes were determined based on pre- and posttreatment lateral cephalograms. Nonparametric tests were applied to test between treatment groups and steps. The Mann-Whitney U test, Kruskal-Wallis, Pearson correlation and Wilcoxon signed-rank test were applied for statistical analysis (p < 0.05). RESULTS The incidence of root resorptions was 89-94.4% in low or moderate level. The relative root-crown ratio (rRCR) was not statistically different between the TSA and control groups except tooth~12. The axis of the incisors in the TSA group was significantly improved. The main direction of movement of the apices of the central incisors was retrusion and extrusion. No interdependence between the amount of resorption and the parameters of treatment duration, extent and direction of apical movement were found. CONCLUSION The results of the study showed that the amount of apical root resorption with the TSA is slight to moderate and can be compared to conventional orthodontic treatment. The TSA is hence a~suitable method for applying targeted torques to the incisors. ZUSAMMENFASSUNG ZIEL: Der Umfang der apikalen Wurzelresorption ebenso wie das Ausmaß und die Richtung der therapeutisch angenommenen apikalen Bewegung sowie die Behandlungsdauer wurden bei Anwendung des Torquesegmentbogens (TSB) untersucht. METHODEN Das Ausmaß der apikalen Wurzelresorption wurde an 18 willkürlich ausgewählten Klasse-II- und -I-Patienten, die mit dem TSB behandelt wurden, und an 18 konventionell behandelten Patienten anhand von prä- und posttherapeutisch erstellten Panoramaschichtaufnahmen beurteilt. Die sagittalen und vertikalen apikalen Bewegungen sowie die Änderungen der Inklination wurden anhand der FRS(Fernröntgenseitenbilder)-Aufnahmen bestimmt. Unterschiede zwischen Behandlungsgruppen und -schritten wurden mit nichtparametrischen Tests bestimmt. Mann-Whitney-U-, Kruskal-Wallis\hbox-, Pearson-Korrelation- und Wilcoxon-Rangsummen-Tests wurden zur statischen Analyse verwendet (p < 0.05). ERGEBNISSE Die Inzidenz der Wurzelresorption betrug 89–94,4 % für geringes bis moderates Ausmaß. Es gab keinen statistisch signifikanten rRCR („relative root–crown ratio“)-Unterschied zwischen der TSB- und der Kontrollgruppe bis auf Zahn 12. Die Inzisivusachse in der TSB-Gruppe wurde signifikant verbessert. Die Hauptbewegungsrichtung der Apices der zentralen Schneidezähne waren Retrusion und Extrusion. Es fand sich keine Interdependenz zwischen dem Umfang der Resorption und den Parametern Behandlungsdauer, Ausmaß und Richtung der apikalen Bewegung. SCHLUSSFOLGERUNG Die Studienergebnisse zeigen, dass der Umfang der apikalen Wurzelresorption mit TSB leicht bis moderat ist und mit der konventionellen orthodontischen Behandlung vergleichbar. Der TSB ist daher geeignet, Torque auf die Schneidezähne zu übertragen

Haemanthus coccineus extract and its main bioactive component narciclasine display profound anti-inflammatory activities in vitro and in vivo

Haemanthus coccineus extracts (HCE) have traditionally been used to treat a variety of diseases, like febrile colds or asthma. Since new therapeutic options against inflammatory processes are still urgently needed, we aimed to pharmacologically characterise the anti-inflammatory potential of HCEin vitro and in vivo and to identify the underlying bioactive component(s). The action of HCE on oedema formation and leucocyte infiltration were analysed in two murine models of inflammation (dermal oedema induced by arachidonic acid and croton oil;kidney injury caused by unilateral ureteral obstruction). The interaction of leucocytes with endothelial cells (ECs) as well as the activation parameters of these two cell types were analysed. Moreover, the nuclear factor B (NFB) pathway was investigated in detail in ECs. Using different fractions of HCE, the bioactive principle was identified. In vivo, HCE (450mg/kg orally or 2mg/kg intraperitoneally) inhibited oedema formation, leucocyte infiltration and cytokine synthesis. In vitro, HCE (100-300ng/ml) blocked leucocyte-EC interaction as well as the activation of isolated leucocytes (cytokine synthesis and proliferation) and of primary ECs (adhesion molecule expression). HCE suppressed NFB-dependent gene transcription in the endothelium, but did not interfere with the NFB activation cascade (IB degradation, p65 nuclear translocation and NFB DNA-binding activity). The alkaloid narciclasine was elucidated as the bioactive compound responsible for the anti-inflammatory action of HCE. Our study highlights HCE and its main alkaloid narciclasine as novel interesting approach for the treatment of inflammation-related disorders

Haemanthus coccineus extract and its main bioactive component narciclasine display profound anti-inflammatory activities in vitro and in vivo

Haemanthus coccineus extracts (HCE) have traditionally been used to treat a variety of diseases, like febrile colds or asthma. Since new therapeutic options against inflammatory processes are still urgently needed, we aimed to pharmacologically characterise the anti-inflammatory potential of HCEin vitro and in vivo and to identify the underlying bioactive component(s). The action of HCE on oedema formation and leucocyte infiltration were analysed in two murine models of inflammation (dermal oedema induced by arachidonic acid and croton oil;kidney injury caused by unilateral ureteral obstruction). The interaction of leucocytes with endothelial cells (ECs) as well as the activation parameters of these two cell types were analysed. Moreover, the nuclear factor B (NFB) pathway was investigated in detail in ECs. Using different fractions of HCE, the bioactive principle was identified. In vivo, HCE (450mg/kg orally or 2mg/kg intraperitoneally) inhibited oedema formation, leucocyte infiltration and cytokine synthesis. In vitro, HCE (100-300ng/ml) blocked leucocyte-EC interaction as well as the activation of isolated leucocytes (cytokine synthesis and proliferation) and of primary ECs (adhesion molecule expression). HCE suppressed NFB-dependent gene transcription in the endothelium, but did not interfere with the NFB activation cascade (IB degradation, p65 nuclear translocation and NFB DNA-binding activity). The alkaloid narciclasine was elucidated as the bioactive compound responsible for the anti-inflammatory action of HCE. Our study highlights HCE and its main alkaloid narciclasine as novel interesting approach for the treatment of inflammation-related disorders

Glycopeptide resistance in Enterococcus spp. and coagulase-negative staphylococci from hospitalised patients in Germany: occurrence, characteristics and dalbavancin susceptibility

Objectives: The aim of this study was to evaluate the occurrence of glycopeptide resistance in enterococci and coagulase-negative staphylococci (CoNS) and to determine the susceptibilities of the identified glycopeptide-resistant isolates to dalbavancin. Methods: Twenty-two medical laboratories participated in the study conducted in 2016/17 by the Paul-Ehrlich-Society for Chemotherapy. Each laboratory was asked to collect 30 Enterococcus spp. (limited to Enterococcus faecalis and Enterococcus faecium) and 30 CoNS isolates consecutively from hospitalised patients with a proven or suspected infection. Results: A total of 1285 isolates were collected, comprising 364 E. faecalis, 291 E. faecium and 630 CoNS. No E. faecalis isolates (0%) but 76 E. faecium isolates (26.1%) were vancomycin-resistant, of which 21 showed the VanA type and 55 the VanB type. The proportion of vancomycin-resistant strains among E. faecium isolates from patients in intensive care units (21.6%) was significantly lower than that from patients on regular wards (30.5%). Among the CoNS, 67 isolates (10.6%) were teicoplanin-resistant but none were vancomycin-resistant, with resistance only detected in Staphylococcus epidermidis (12.2%), Staphylococcus haemolyticus (17.9%) and Staphylococcus hominis (13.2%). Dalbavancin at ≤0.25 mg/L inhibited all VanB-type enterococci and 95.5% of teicoplanin-resistant CoNS. Conclusion: The level of glycopeptide resistance in E. faecalis remains very low in Germany but achieved 26% in E. faecium and was >10% in CoNS. Dalbavancin appears to be a feasible option for treating infections caused by VanB-type vancomycin-resistant E. faecium and teicoplanin-resistant CoNS.Peer Reviewe

N-Aryl mercaptoacetamides as potential multi-target inhibitors of metallo-β-lactamases (MBLs) and the virulence factor LasB from Pseudomonas aeruginosa

Increasing antimicrobial resistance is evolving to be one of the major threats to public health. To reduce the selection pressure and thus to avoid a fast development of resistance, novel approaches aim to target bacterial virulence instead of growth. Another strategy is to restore the activity of antibiotics already in clinical use. This can be achieved by the inhibition of resistance factors such as metallo-β-lactamases (MBLs). Since MBLs can cleave almost all β-lactam antibiotics, including the “last resort” carbapenems, their inhibition is of utmost importance. Here, we report on the synthesis and in vitro evaluation of N-aryl mercaptoacetamides as inhibitors of both clinically relevant MBLs and the virulence factor LasB from Pseudomonas aeruginosa. All tested N-aryl mercaptoacetamides showed low micromolar to submicromolar activities on the tested enzymes IMP-7, NDM-1 and VIM-1. The two most promising compounds were further examined in NDM-1 expressing Klebsiella pneumoniae isolates, where they restored the full activity of imipenem. Together with their LasB-inhibitory activity in the micromolar range, this class of compounds can now serve as a starting point for a multi-target inhibitor approach against both bacterial resistance and virulence, which is unprecedented in antibacterial drug discovery